DEB SCHWEDHELM
HIGH SCHOOL SENIORS
CHILDREN & FAMILIES
FINE ART
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HIGH SCHOOL SENIORS
CHILDREN & FAMILIES
FINE ART
NAME
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First Name
Last Name
ADDRESS
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
EMAIL
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EMERGENCY NAME AND PHONE NUMBER
INHERENT RISKS
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By participating in Deb Schwehelm Photography retreat, you may be exposed to several inherent risks, including but not limited to those listed below: Tripping and falling Abrasions, cuts, and contusions Broken bones Dehydration Heat exhaustion Blisters Pulled muscles Twisted ankles Leg or arm injuries Encounters with wildlife and insects Submersion in water Exposure to unpredictable inclement weather Broken camera and equipment I have read and understand the inherent risks listed above.
Yes
No
WAIVER AND RELEASE OF LIABILITY AGREEMENT
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Assumption of Risk. I understand that participating in the Activity entails inherent risks of physical injury, including, but not limited to, the risks possibly injury, disability, and death. I have been given the chance to ask questions regarding risks and all such questions have been answered to my satisfaction. Having read this form, I am fully aware of the risks and hazards associated with the Deb Schwedhelm Photography retreat, and hereby elect to voluntarily participate in the retreat and associated activities. I voluntarily assume full responsibility for any risks of loss, property damage or personal injury, including death, that may be sustained by me as a result of participating in the retreat activities, unless caused by the gross negligence or willful misconduct, its officers, trustees, agents, employees or volunteers. Liability Release. In consideration for Deb Schwedhelm Photography allowing me to participate in the retreat, I agree that I release Deb Schwedhelm and Deb Schwedhelm Photography from any and all liabilities, claims, demands, actions, causes of actions, costs and expenses of any nature whatsoever arising out of any loss, damage, or injury, including death, that may be sustained by me or to any property belonging to me, arising from activities or while upon the premises where the activity is being conducted, excepting those claims arising from the gross negligence or willful misconduct. Indemnification. I agree to indemnify and hold harmless Deb Schwedhelm from and against any loss, liability, damage or costs, including court costs and attorneys’ fees, that Deb Schwedhelm may incur arising from my involvement in activities. Warranty of Physical Fitness. I warrant that I am physically fit and in a condition that will allow me to participate fully in the retreat activities. I maintain medical insurance that covers me for accidents and illnesses while I am participating in this retreat. I understand Deb Schwehdelm Photography has not made, nor will make, any investigation into my physical fitness or ability to participate in activities and Deb Schwedhelm is relying on my warranty of my physical condition. I assume full responsibility for payment of medical expenses not covered by my insurance incurred as a result of my participation in all retreat activities. Emergency Medical Treatment. I grant the Deb Schwedhelm permission to authorize emergency medical treatment as it deems appropriate, and agree that such action by Deb Schwedhelm shall be subject to the terms of this Agreement. I understand and agree that Deb Schwedhelm assumes no responsibility for any injury or damage that might arise out of or in connection with such authorized emergency medical treatment. Intent. It is my express intent that this Agreement shall bind the members of my family and spouse (if any), my estate, heirs, administrators, assigns, and personal representatives. I agree that this Agreement and any claim arising from my participation in the retreat activities shall be construed in accordance with the laws of the State of Virginia, without regard to its conflict of laws provision. The courts in Virginia shall be the forum for any lawsuits arising from the activities or incident to this Agreement. The terms of this Agreement shall be severable, such that if a court of competent jurisdiction holds any term to be illegal or unenforceable, the validity of the remaining portions of shall not be affected thereby. In signing this Agreement, I acknowledge that I have read this Release Agreement form, understand it, and agree to be bound by its terms. I further acknowledge that this is my digital signature below and sign this Release Agreement voluntarily.
First Name
Last Name
DATE
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Thank you!